Immediate Operative Trauma Assessment Score: A Simple and Reliable Predictor of Mortality in Trauma Patients Undergoing Urgent/Emergent Surgery

Objective: Many current trauma mortality prediction tools are either too intricate or rely on data not readily available during a trauma patient's initial evaluation. Moreover, none are tailored to those necessitating urgent or emergent surgery. Our objective was to design a practical, user-friendly scoring tool using immediately available variables, and then compare its efficacy to the widely-known Revised Trauma Score (RTS). Methods: The adult 2017-2021 Trauma Quality Improvement Program (TQIP) database was queried to identify patients ≥18 years old undergoing any urgent/emergent operation (direct from Emergency Department to operating room). Patients were divided into derivation and validation groups. A three-step methodology was used. First, multiple logistic regression models were created to determine risk of death using only variables available upon arrival. Second, the weighted average and relative impact of each independent predictor was used to derive an easily calculated Immediate Operative Trauma Assessment Score (IOTAS). We then validated IOTAS using AUROC and compared it to RTS. Results: From 249 208 patients in the derivation-set, 14 635 (5.9%) died. Age ≥65, Glasgow Coma Scale score <9, hypotension (SBP <90 mmHg), and tachycardia (>120/min) on arrival were identified as independent predictors for mortality. Using these, the IOTAS was structured, offering scores between 0-8. The AUROC for this was .88. A clear escalation in mortality was observed across scores: from 4.4% at score 1 to 60.5% at score 8. For the validation set (250 182 patients; mortality rate 5.8%), the AUROC remained consistent at .87, surpassing RTS's AUROC of .83. Conclusion: IOTAS is a novel, accurate, and now validated tool that is intuitive and efficient in predicting mortality for trauma patients requiring urgent or emergent surgeries. It outperforms RTS, and thereby may help guide clinicians when determining the best course of action in patient management as well as counseling patients and their families.

Unit-Based Nurses' Development of a Couplet Care Acuity Scoring Tool

OBJECTIVE

To evaluate content validity (CV) and interrater reliability (IRR) of an acuity scoring tool developed for the couplet care/postpartum/nursery patient population and to determine if there was agreement between supervisor or director scoring and staff scoring.

DESIGN

A scoring tool to assess the acuity of the couplet care/postpartum/nursery patients was developed.

SETTING

Two hospitals: one Level 2 hospital, one Level 3 hospital. Unit-based patient care councils participated in the development, and all couplet care nurses participated in scoring patients for testing.

MEASUREMENTS

The final tool was evaluated for CV and IRR using expert review, universal agreement scores, and discriminant content validation.

RESULTS

Regarding CV for the Couplet Care Acuity Scoring Tool, the average of the number of experts in agreement divided by the total number of experts across all items was 1.00. Regarding IRR, the intraclass correlation coefficient was 0.85, indicating that the tool is valid and reliable for the study sample.

CONCLUSION

The tool was reliable and valid in this study. Future testing is needed with larger samples and different health care facilities.

Scoring big: Aligning inpatient clinical pharmacy services through implementation of an electronic scoring system

PURPOSE

Data are limited on utilizing a comprehensive scoring system in the electronic health record to help prioritize, align, and standardize clinical pharmacy services across multiple hospitals and practice models within a health system. The purpose of this article is to describe the development and implementation of an electronic scoring system to help inpatient pharmacists prioritize patient care activities and standardize clinical services across a diverse health system.

SUMMARY

Inpatient pharmacists from all specialty areas across the health system partnered with health information technology pharmacists to develop a scoring system directly integrated into the electronic health record that would help triage patient care, identify opportunities for pharmacist intervention, and prioritize clinical pharmacy services. Individual variables were built based on documented patient parameters such as use of high-risk medications, pharmacy consults, laboratory values, disease states, and patient acuity. Total overall scores were assigned to patients based on the sum of the scores for the individual variables, which update automatically in real time. The total scores were designed to help inpatient pharmacists prioritize patients with higher scores, thus reducing the need for manual chart review to identify high-risk patients.

CONCLUSION

An electronic scoring system with a tiered point system developed for inpatient pharmacists creates a method to prioritize and align clinical pharmacy services across a health system with diverse pharmacy practice models.

The DEPARTS Score: A Novel Tool for Predicting Discharge Disposition in Geriatric Trauma Patients

BACKGROUND

Geriatric trauma patients (GTPs) represent a high-risk population for needing post-acute care, such as skilled nursing facilities (SNFs) and long-term acute care hospitals (LTACs), due to a combination of traumatic injuries and baseline functional health. As there is currently no well-established tool for predicting these needs, we aimed to create a scoring tool that predicts disposition to SNFs/LTACs in GTPs.

METHODS

The adult 2017 Trauma Quality Improvement Program database was divided at random into two equal sized sets (derivation and validation sets) of GTPs >65 years old. First, multiple logistic regression models were created to determine risk factors for discharge to a SNF/LTAC in admitted GTPs. Second, the weighted average and relative impact of each independent predictor was used to derive a DEPARTS (Discharge of Elderly Patients After Recent Trauma to SNF/LTAC) score. We then validated the score using the area under the receiver-operating curve (AROC).

RESULTS

Of 66 479 patients in the derivation set, 36 944 (55.6%) were discharged to a SNF/LTAC. Number of comorbidities, fall mechanism, spinal cord injury, long bone fracture, and major surgery were each independent predictors for discharge to SNF/LTAC, and a DEPARTS score was derived with scores ranging from 0 to 19. The AROC for this was .74. In the validation set, 66 477 patients also had a SNF/LTAC discharge rate of 55.7%, and the AROC was .74.

DISCUSSION

The DEPARTS score is a good predictor of SNF/LTAC discharge for GTPs. Future prospective studies are warranted to validate its accuracy and clinical utility in preventing delays in discharge.

TRASS: a global approach to assess the severity of truncal acne

INTRODUCTION

Only a small amount of published data regarding truncal acne is available and no proper tool to assess its severity exists.

AIM

to provide dermatologists with an easy-to-use tool to assess truncal acne (TRASS, truncal acne severity scale) using a global approach.

METHODS

A scoring tool that assesses the severity of acne (based on GEA and ECLA scales) on the trunk using a global approach was built, including three subscores: family history, clinical signs and quality of life (QoL). In order to test TRASS, the experts used photos of 47 patients attending their clinics with truncal acne. The ROP (Regression OPtimized) model was applied to assess the diagnosis performance of TRASS and to identify items contributing to the classification of the patients. Internal testing was made to demonstrate the robustness of the model. Correlation analyses between the different items were performed to evaluate the interaction between the different items and their impact on the severity grading of truncal acne.

RESULTS

Patients with the most severe acne were identified by TRASS. The error level was 6.6% after internal validation and 10.4% when using the median value or the centile 75^th (6.6% and 10.4%). Correlation was significant between systemic treatment and scars (p=0.0025) and nodules (p=0.01988) and between location and QoL (p=0.0095).

CONCLUSION

TRASS is the first global, patient-centred approach to evaluate truncal acne by scoring the importance of each factor independently from its clinical severity. TRASS may allow the practitioner to choose and validate the most suitable therapy together with the patient in order to treat his or her truncal acne successfully and to limit treatment failure.

Development and Validation of an Objective Scoring Tool for Robot-Assisted Partial Nephrectomy: Scoring for Partial Nephrectomy

Objective: To develop a structured and objective scoring tool for assessment of robot-assisted partial nephrectomy (RAPN): Scoring for Partial Nephrectomy (SPaN). Materials and Methods: Content development: RAPN was deconstructed into 6 domains by a multi-institutional panel of 10 expert robotic surgeons. Performance on each domain was represented on a Likert scale of 1 to 5, with specific descriptions of anchors 1, 3, and 5. Content validation: The Delphi methodology was utilized to achieve consensus about the description of each anchor for each domain in terms of appropriateness of the skill assessed, objectiveness, clarity, and unambiguous wording. The content validity index (CVI) of ≥0.75 was set as cutoff for consensus. Reliability: 15 de-identified videos of RAPN were utilized to determine the inter-rater reliability using linearly weighted percent agreement, and Construct validation of SPaN was described in terms of median scores and odds ratios. Results: The expert panel reached consensus (CVI ≥0.75) after 2 rounds. Consensus was achieved for 36 (67%) statements in the first round and 18 (33%) after the second round. The final six-domain SPaN included Exposure of the kidney; Identification and dissection of the ureter and gonadal vessels; Dissection of the hilum; Tumor localization and exposure; Clamping and tumor resection; and Renorrhaphy. The linearly weighted percent agreement was >0.75 for all domains. There was no difference between median scores for any domain between attendings and trainees. Conclusion: Despite the lack of significant construct validity, SPaN is a structured, reliable, and procedure-specific tool that can objectively assesses technical proficiency for RAPN.

The Plate Objective Scoring Tool (POST): Further Reflections and Extended Applications

Hypospadias is a common birth defect of the male external genitalia. However, there are conflicting arguments about the optimal classification approach and ideal surgical technique. We have introduced the Plate Objective Scoring Tool (POST) to define critical glanular phenotypic landmarks of the urethral plate. We propose that POST can objectively, reproducibly, and accurately determine urethral plate quality, thus permitting robust comparison between the different surgical techniques commonly utilized in hypospadias repair. Furthermore, the POST scoring system represents a versatile tool that can objectively quantify key variables in hypospadiology that are currently not well defined. Further validation of POST should lead to better identification and management of postoperative complications.

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Prehospital Variables Alone Can Predict Mortality After Blunt Trauma: A Novel Scoring Tool

BACKGROUND

We sought to develop a novel Prehospital Injury Mortality Score (PIMS) to predict blunt trauma mortality using only prehospital variables.

STUDY DESIGN

The 2017 Trauma Quality Improvement Program database was queried and divided into two equal sized sets at random (derivation and validation sets). Multiple logistic regression models were created to determine the risk of mortality using age, sex, mechanism, and trauma activation criterion. The PIMS was derived using the weighted average of each independent predictor. The discriminative power of the scoring tool was assessed by calculating the area under the receiver operating characteristics (AUROC) curve. The PIMS ability to predict mortality was then assessed by using the validation cohort. The score was compared to the Revised Trauma Score (RTS) using the AUROC curve, including a subgroup of patients with normal vital signs.

RESULTS

The derivation and validation groups each consisted of 163 694 patients. Seven independent predictors of mortality were identified, and the PIMS was derived with scores ranging from 0 to 20. The mortality rate increased from 1.4% to 43.9% and then 100% at scores of 1, 10, and 19, respectively. The model had very good discrimination with an AUROC of .79 in both the derivation and validation groups. When compared to the RTS, the AUROC were similar (.79 vs. .78). On subgroup analysis of patients with normal prehospital vital signs, the PIMS was superior to the RTS (.73 vs. .56).

CONCLUSION

The PIMS is a novel scoring tool to predict mortality in blunt trauma patients using prehospital variables. It had improved discriminatory power in blunt trauma patients with normal vital signs compared to the RTS.

The pruritus severity scale-a novel tool to assess itch in burns patients

BACKGROUND

Pruritus assessment is difficult due to the varying subjective nature of the experience. There have been several validated tools described to quantify the severity of itch, however these tools fail to provide a comprehensive assessment or are too cumbersome and therefore lack usability. Our novel burn assessment tool, "The Pruritus Severity Scale" (PSS) allows for accurate quantification of itch components. The aim of this study was to assess its use in the burns population.

METHODS

A prospective observational study was conducted on all patients over five years of age with a burn injury over a six month period. Patients underwent subjective evaluation of their itch as determined by two validated scores, the Visual Analogue Scale (VAS) and the Itch Man scale (IMS) and in addition to the PSS. The pruritus severity scale was correlated with the previously validated scoring methods using bi-variate correlations.

RESULTS

Twenty-two patients were included in the study. The most common cause of injury was due to flame burn. The mean total body surface area was 6.5% (range: 1-26%). Both the IMS and the VAS positively correlated well with the PSS. The Spearman Coefficient for the PSS vs IMS was 0.81, R² = 0.65 (P<0.05). The Spearman Coefficient for the PSS vs VAS was 0.87 (R² = 0.76 (P<0.01)). There is a positive linear relationship between our novel scoring methods and the currently validated methods, indicating its validity as a burn assessment too.

CONCLUSION

The Pruritus Severity Scale was shown to be an accurate, objective tool that was able to effectively record the patient's experience of itch. We believe that this novel score is quick, easy to use and allows for more comprehensive assessment than other short assessment tools.

A Scoring Tool to Estimate the Survival of Elderly Patients With Brain Metastases from Esophageal Cancer Receiving Whole-brain Irradiation

BACKGROUND/AIM

Elderly patients with metastatic esophageal cancer may benefit from individualized therapies. A tool to predict the survival of such patients with brain metastases was created.

PATIENTS AND METHODS

In 11 elderly patients (≥65 years) receiving whole-brain irradiation (WBI) for brain metastases from esophageal cancer, age, gender, performance status, number of brain metastases, metastases outside the brain, time between cancer diagnosis and WBI, and WBI regimen were evaluated for survival.

RESULTS

On univariate analyses, age ≥73 years (p=0.046) and time between diagnosis of esophageal cancer and WBI ≤6 months (p=0.046) were significantly associated with poorer survival. On multivariate analysis, both showed a trend. Based on these two factors, the following points were assigned: age ≤72 years=1 point, age ≥73 years=0 points; time between cancer diagnosis and WBI >6 months=1 point, and ≤6 months=0 points. Three prognostic groups were thus formed: 0, 1 and 2 points. Survival rates of these groups at 6 months were 0%, 0% and 40% (p=0.012), respectively.

CONCLUSION

This new tool allows estimation of survival and treatment individualization in elderly patients irradiated for brain metastases from esophageal cancer.

Characterization of changes in medication complexity using a modified scoring tool

PURPOSE

The purpose of this study was to characterize dynamic changes in medication regimen complexity over time in critically ill adults and to validate a modified version of the medication regimen complexity-intensive care unit (MRC-ICU) scoring tool.

SUMMARY

A single-center, retrospective, observational chart review was conducted with a primary aim of assessing changes in medication regimen complexity over time, as measured by both the 39-item MRC-ICU scoring tool and a modified version (the mMRC-ICU) containing just 17 items. Secondary aims included validation of the mMRC-ICU and exploration of relationships between medication regimen complexity and ICU length of stay (LOS), inpatient mortality, and patient acuity. Adults admitted to a medical ICU from November 2016 through June 2017 were included. The medication regimens of a total of 130 patients were scored in order to test, modify, and validate the MRC-ICU and mMRC-ICU tools. The modified tool was validated by evaluating correlation of mMRC-ICU scores with MRC-ICU scores and with patient outcomes including patient acuity, ICU LOS, and inpatient mortality. mMRC-ICU scores were collected at 24 and 48 hours after admission and at ICU discharge to evaluate changes over time. Significant changes in medication regimen complexity over time were observed, with the highest scores observed at 24 hours after admission.

CONCLUSION

Medication regimen complexity may provide valuable insights into pharmacist activity and resource allocation. Further validation of the MRC-ICU and mMRC-ICU scoring tools in other critically ill populations and at external sites is required.

Multicenter validation of a novel medication-regimen complexity scoring tool

BACKGROUND

The MRC-ICU, a novel regimen complexity scoring tool, provides an objective measure of medication regimen complexity in critically ill patients. The MRC-ICU may have the ability to evaluate the impact of critical care pharmacists on patient outcomes but requires further validation. The objective of this study was to confirm the external validity of the MRC-ICU scoring tool at multiple institutions and intensive care unit (ICU) settings.

METHODS

This was a multicenter, prospective, observational study. The electronic medical record was reviewed to collect patient demographics and patient outcomes, and the medication administration record was reviewed to collect MRC-ICU scores at 24 hours, 48 hours, and ICU discharge. Validation was performed by assessing convergent and divergent validity of the score. Spearman rank-order correlation was used to determine correlation.

RESULTS

A total of 230 patients were evaluated across both centers in both medical ICUs and surgical ICUs. Differences between the original center and the new site included that total number of orders (29 vs 126; P < 0.001) and total number of medication orders (17 vs 36; P < 0.001) were higher at the new site, whereas the original site had higher overall MRC-ICU scores (14 vs 11; P = 0.004). The MRC-ICU showed appropriate convergent validity with number of orders and medication orders (all P < 0.001) and appropriate divergent validity with no significant correlation found between age, weight, or gender (all P > 0.05).

CONCLUSIONS

External validity of the MRC-ICU has been confirmed through evaluation at an external site and in the surgical ICU population. The MRC-ICU scoring tool requires prospective evaluation to provide objective data regarding optimal pharmacist use.

Development and validation of a medication regimen complexity scoring tool for critically ill patients

PURPOSE

The purpose of this study was to develop and validate a novel medication regimen complexity-intensive care unit (MRC-ICU) scoring tool in critically ill patients and to correlate MRC with illness severity and patient outcomes.

METHODS

This study was a single-center, retrospective observational chart review of adults admitted to the medical ICU (MICU) between November 2016 and June 2017. The primary aim was the development and internal validation of the MRC-ICU scoring tool. Secondary aims included external validation of the MRC-ICU and exploration of relationships between medication regimen complexity and patient outcomes. Exclusion criteria included a length of stay of less than 24 hours in the MICU, active transfer, or hospice orders at 24 hours. A total of 130 patient medication regimens were used to test, modify, and validate the MRC-ICU tool.

RESULTS

The 39-line item medication regimen complexity scoring tool was validated both internally and externally. Convergent validity was confirmed with total medications (p < 0.0001). Score discriminant validity was confirmed by lack of association with age (p = 0.1039) or sex (p = 0.7829). The MRC-ICU score was significantly associated with ICU length of stay (p = 0.0166), ICU mortality (p = 0.0193), and patient acuity (p < 0.0001).

CONCLUSION

The MRC-ICU scoring tool was validated and found to correlate with length of stay, inpatient mortality, and patient acuity.

Continuing medical education and pharmaceutical industry involvement: An evaluation of policies adopted by Canadian professional medical associations

BACKGROUND

Professional medical associations (PMAs) play a crucial role in providing accredited continuing medical education (CME) to physicians. Funding from the pharmaceutical industry may lead to biases in CME.

OBJECTIVE

This study examines publicly available policies on CME, adopted by Canadian PMAs as of December 2015.

METHODS

Policies were evaluated using an original scoring tool comprising 21 items, two questions about PMAs' general and CME funding from industry, and three enforcement measures.

RESULTS

We assessed 236 policies adopted by Canadian PMAs (range, 0 to 32). Medical associations received summative scores that ranged from 0% to 49.2% of the total possible points (maximum score = 63). Twenty-seven associations received an overall score of 0%. The highest mean scores were achieved in the areas of industry involvement in planning CME activities (mean: 1.1/3), presence of a review process for topics of CME activities (mean: 1.1/3), content review for balanced information (mean: 1.1/3), and responsibility of distribution of funds (mean: 1.0/3). The lowest mean scores were achieved in the areas of awards (mean: 0.0/3), industry personnel, representatives, and employees (mean: 0.1/3), distribution of industry-funded educational materials at CME activities (mean: 0.1/3), and distinction between marketing and educational materials (mean: 0.1/3).

CONCLUSION

These results suggest that Canadian PMAs' publicly available policies on industry involvement in CME are generally weak or non-existent; therefore, the accredited CME that is provided to Canadian physicians may be viewed as open to bias. We encourage all Canadian medical associations to strengthen their policies to avoid the potential for industry influence in CME.

Development of a quality scoring tool to assess quality of discharge summaries

Introduction:

Timely, precise, and relevant communication between hospital-based clinicians and primary care physicians post-discharge (DC) ensures quality transitions, thereby reducing patient safety incidents and preventing readmission. At the present time there is limited knowledge of elements of quality or methods to score the quality criteria in the context of DC summaries. The Nova Scotia Health Authority, a provincial health system responsible for the delivery of services in a small Canadian province, embarked on a system-level approach to the standardization of DC summaries in an effort to improve quality and safety at care transitions from hospital to primary care.

Materials and Methods:

A comprehensive literature review to retrieve items relevant to quality in DC summaries, retrospective audit of charts, a consensus development process, and, finally, validation of a scoring tool were conducted in order to develop a quality scoring tool for DC summaries.

Results:

Relevant items were identified through the literature review and consensus development process. Corresponding definitions that were established assisted the development of the quality criteria, which were subsequently used to score the quality of DC summaries in our organization.

Conclusion:

The scoring tool developed through this work will be applied to help us gain a more in-depth understanding of quality in DC summaries and support the development of suitable education and quality processes in the health authority that can best support safe care transitions for patients.

A Prognostic Scoring Tool for Cesarean Organ/Space Surgical Site Infections: Derivation and Internal Validation

BACKGROUND

Organ/space surgical site infections (SSIs) are serious complications after cesarean delivery. However, no scoring tool to predict these complications has yet been developed. This study sought to develop and validate a prognostic scoring tool for cesarean organ/space SSIs.

METHODS

Data for case and non-case of cesarean organ/space SSI between January 1, 2007 and December 31, 2012 from a tertiary care hospital in Thailand were analyzed. Stepwise multivariable logistic regression was used to select the best predictor combination and their coefficients were transformed to a risk scoring tool. The likelihood ratio of positive for each risk category and the area under receiver operating characteristic (AUROC) curves were analyzed on total scores. Internal validation using bootstrap re-sampling was tested for reproducibility.

RESULTS

The predictors of 243 organ/space SSIs from 4,988 eligible cesarean delivery cases comprised the presence of foul-smelling amniotic fluid (four points), vaginal examination five or more times before incision (two points), wound class III or greater (two points), being referred from local setting (two points), hemoglobin less than 11 g/dL (one point), and ethnic minorities (one point). The likelihood ratio of cesarean organ/space SSIs with 95% confidence interval among low (total score of 0-1 point), medium (total score of 2-5 points), and high risk (total score of ≥6 points) categories were 0.11 (0.07-0.19), 1.03 (0.89-1.18), and 13.25 (10.87-16.14), respectively. Both AUROCs of the derivation and validation data were comparable (87.57% versus 86.08%; p = 0.418).

CONCLUSIONS

This scoring tool showed a high predictive ability regarding cesarean organ/space SSIs on the derivation data and reproducibility was demonstrated on internal validation. It could assist practitioners prioritize patient care and management depending on risk category and decrease SSI rates in cesarean deliveries.

Validation of a fentanyl transdermal adhesion scoring tool for use in clinical practice

CONTEXT

The therapeutic efficacy of a transdermal system (TDS) is directly related to the adhesion of TDS, with partial adhesion resulting in lower plasma concentration. Currently there is no TDS adhesion scoring tool available for use in the clinical setting.

OBJECTIVES

To validate a U.S. Food and Drug Administration (FDA) scoring system for the adhesion of the fentanyl TDS in cancer patients.

METHODS

A library of images was created from photographs of fentanyl/placebo TDS placed on patients/volunteers. Thirty photographs, reflecting varying degrees of adhesion, were selected for each of series A and B, with 10 photographs common to both series. Each series was shown to 30 health professionals asked to score the photographs using the FDA scoring system. Validity was assessed using Spearman's rank correlation and reliability by Cohen's kappa (k). Photo editing software was used to assign control scores to each photograph.

RESULTS

Validity was high for both series (≥ 0.954). Inter-reliability (k) ranged from 0.327 to 0.858 (average, 0.547) and 0.433-0.910 (average, 0.620) in series A and B, respectively. The combined agreement across both series was 0.585. Intra-rater agreement (k) of the 10 common images was 0.605. No significant difference was observed between the scoring patterns for those with more than 10 years of working experience.

CONCLUSION

Overall, the TDS adhesion score determined by the participants visually in this study corresponded well to those generated by photo editing software, thus rendering the scoring system highly valid. The FDA scoring system is an adequate tool for assessing fentanyl TDS adhesion in clinical practice.

In utero exposure to Black Bull chewing tobacco and neonatal nicotine withdrawal: a review of the literature

Among the indigenous people of the Yukon-Kuskokwim Delta area of Alaska, a homemade moist chewing tobacco known as Black Bull or "iq'mik" is widely used. Intake of various tobacco products is reported to be more than 80 percent in pregnant women throughout this area, with up to 60 percent of the pregnant women admitting to regular use of Black Bull. High levels of nicotine, cotinine, heavy metals, and other chemicals are known to pass to the fetus. Neonatal exposure to maternal tobacco use has been studied for the past three decades and has been shown to cause neonatal passive addiction and subsequent withdrawal symptoms. The intensified exposure and withdrawal experienced by infants passively subjected to Black Bull warrant further study.

The STAR score: a method for auditing clinical records

INTRODUCTION

Adequate medical note keeping is critical in delivering high quality healthcare. However, there are few robust tools available for the auditing of notes. The aim of this paper was to describe the design, validation and implementation of a novel scoring tool to objectively assess surgical notes.

METHODS

An initial 'path finding' study was performed to evaluate the quality of note keeping using the CRABEL scoring tool. The findings prompted the development of the Surgical Tool for Auditing Records (STAR) as an alternative. STAR was validated using inter-rater reliability analysis. An audit cycle of surgical notes using STAR was performed. The results were analysed and a structured form for the completion of surgical notes was introduced to see if the quality improved in the next audit cycle using STAR. An education exercise was conducted and all participants said the exercise would change their practice, with 25% implementing major changes.

RESULTS

Statistical analysis of STAR showed that it is reliable (Cronbach's α = 0.959). On completing the audit cycle, there was an overall increase in the STAR score from 83.344% to 97.675% (p < 0.001) with significant improvements in the documentation of the initial clerking from 59.0% to 96.5% (p < 0.001) and subsequent entries from 78.4% to 96.1% (p < 0.001).

CONCLUSIONS

The authors believe in the value of STAR as an effective, reliable and reproducible tool. Coupled with the application of structured forms to note keeping, it can significantly improve the quality of surgical documentation and can be implemented universally.